Elective waits will not recover until 2019, says Stevens

In the Next Steps on the NHS Five Year Forward View, NHS England said the demand for elective treatments is likely to grow faster than the NHS’s capacity to meet the target, and suggests this may cause average waits for routine surgery to increase.

The admission prompted the Royal College of Surgeons to claim the target has been “jettisoned in all but name”.

NHS England chief executive Simon Stevens told HSJ that while the 92 per cent target remains the “constitutional goal” the NHS had to be realistic in what it can achieve.

He added that the NHS mandate said the target of 92 per cent of patients waiting no longer than 18 weeks remained a “constitutional goal and a 2020 objective”, but the delivery plan laid out “what we think the actuality is going to be” in 2017-18.

The document, published today, said: “Given multiple calls on the constrained NHS funding growth over the next couple of years, elective volumes are likely to expand at a slower rate than implied by a 92 per cent RTT incomplete pathway target.

“While the median wait for routine care may move marginally, this still represents strong performance compared both to the NHS’s history and comparable other countries.”

Mr Stevens said the £2bn pledged by chancellor Philip Hammond for social care to free up 2,000-3,000 hospital beds will release a large quantity of elective operating capacity.

But he said the NHS had to be realistic about what these gains will be. “You can second guess what the net effect of that will be, but we are being realistic that it’s important but we are not asking the impossible,” he added.

The delivery plan named cancer as one of three national priorities, along with emergency care and expanding access to primary care. It pledged £130m for the biggest modernising of radiotherapy services in 15 years, with £94m for equipping hospitals with linear accelerators over the next 18 months.

NHS England will introduce the new rapid 28 day cancer diagnosis from April 2018, with extra funding for cancer alliances to be subject to performance incentives for the current 62 day waiting time standard.

The document also pledged to support sustainability and transformation partnerships that seek to split “hot” emergency and urgent care from “cold” planned surgery facilities to allow more efficient bed use.

Mr Stevens said this means STP regions that submit bids for the £325m capital funding announced in the budget for the hot/cold split were more likely to be successful.

He added: “Decisions to make on how we allocate capital and clear productivity gains are a strong reason for [giving money].”

But the plan has sparked concern from the RCS, which accused NHS England of “jettisoning” the 18 week RTT standard.

College president Clare Marx welcomed the plan to “protect planned surgery facilities from the impact of high numbers of emergency patients”.

But she added: “It will be difficult for the general public to understand how waving the white flag on the 18-week target is compatible with a vision of an improved health service.

“It is absolutely right to look at how beds in hospitals can be made available by supporting patients to receive care and support in the community.

“We also welcome NHS England’s plan to look at protecting planned surgery facilities from the impact of high numbers of emergency patients needing beds.

“However, we are concerned that the 18 week waiting times target for surgical treatment has now effectively been jettisoned in all but name having been dropped from the list of priorities for the next 12 months.”